2)require to assess the professional competence of a health care specialist, without relieving him of his duties;
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3)annul the accrediting of a health care specialist for health care activities.
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Article 81Control of the Activity of the Closed Budgetary Institution
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1.The control of activity of a closed budgetary institution shall be performed according to the procedure established by the Government.
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2.The public character of the activity of a closed budgetary institution shall be ensured by the procedure established in the regulations of these institutions.
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Article 82Control of the Incoming Budgetary Funds Obtained
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by a Profit Institution If the profit institutions shall be funded from the state or municipal budgets according to the procedure established by laws, the Ministry of Health and its authorised institutions, State Control officers and municipal ombudsmen shall have the right to inspect how these funds shall be utilised.
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PART IV
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THE PROCEDURE OF RENDERING FREE AND PAID SERVICES AT LNHS INSTITUTIONS
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Chapter I
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FREE SERVICES
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Article 83Individuals Having the Right to Free Services at LNHS Institutions
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1.The following shall have the right to free services at LNHS institutions:
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1)citizens of the Republic of Lithuania and their minor children;
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2)permanent residents of the Republic of Lithuania and their minor children;
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3)individuals, who are not citizens of the Republic of Lithuania, but have a permit for temporary residence in Lithuania and their minor children.
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2.The individuals indicated in paragraphs 1, 2 and 3 of part one of this Article shall henceforth be referred to as permanent residents in this Law.
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3.LNHS institutions shall furnish free requisite medical aid of the nomenclature and assortment denoted by the Republic of Lithuania for aliens, unless it shall be otherwise stipulated in international agreements of the Republic of Lithuania.
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4.The Ministry of Health along with the Ministry of Internal Affairs shall establish the forms and procedure for submitting to LNHS Institutions the documents certifying the qualification of residents as persons listed in paragraphs 1,2 and 3 of part 1 of this Article.
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Article 84The Establishment of the Nomenclature of Free Services Extended
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to Permanent Residents 1. Free services shall be rendered to all permanent residents only, in accordance with the nomenclature of free services approved in Article 85 of this Law.
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2.Free services shall be rendered to individuals in categories listed in paragraphs 2, 4, 5, 6, and 8 of part 1 of Article 18 of this Law, in accordance with all types of individual health care, indicated in Chapter II of Part II of the Law on the Health System and the assortment of these services approved by the Government.
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3.The free services rendered to the categories of individuals listed in paragraph 3 of the first part of Article 18, in accordance with the types of individual health care services approved by the Government and the assortment of these services approved by the Government, upon the recommendation of the Ministry of Internal Affairs and the Ministry of Health.
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4.The range of free dental care services and procedure of the rendering thereof shall be established by the Law on Dental Care (assistance), other laws and legal acts and normative documents.
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Article 85Nomenclature of the Free Services, Rendered to All Permanent
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Residents 1.The nomenclature of free preventative medical aid services includes:
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1)information services on questions regarding diseases the treatment and prophylaxis whereof, shall be compensated from state or municipal budget funds;
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2)immunoprophylaxis and chemoprophylaxis of diseases on the list of contagious diseases approved by the Ministry of Health;
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3)prophylactic tests in accordance with the list established by the Government of the professions, jobs, enterprises and individuals, who had associated with patients, suffering from contagious diseases, included on the list approved by the Ministry of Health. Prophylactic tests according to the requirements of the Laws on Labour Safety and Health Insurance shall not be included on the list indicated in this paragraph.
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2.The nomenclature of free reconstructive medical aid services:
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1)requisite medical aid in accordance with the disease and injury groups approved by the Government;
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2)prostheses of teeth, limbs, joints and other organs affected by the diseases indicated on the list approved by the Government (with the exception of the prostheses compensated from compulsory health insurance funds);
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3)haemodialysis, blood transfusions;
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4)transplantation of tissue and organs, in accordance with the ranges approved by the Government.
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3.The nomenclature of free medical rehabilitation, nursing and social services:
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1)nursing and social services at hospitals for support treatment and nursing for the duration not to exceed more than four months per calendar year;
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2)medical rehabilitation, when suffering from diseases indicated on the list approved by the Government;
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3)services, that are relegated to health care, in accordance with Article 47 of the Law on the Health System.
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4.The nomenclature of free services rendered in individual health care expert examination:
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1)medical expert examination with regard to temporary work disability;
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2)medical expert examination with regard to extended duration and total work disability;
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3)legal medical expert examination according to decision of inquest, investigative bodies, prosecutor, or court;
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4)forensic psychiatric and forensic narcological expert examination according to the decisions by the investigation bodies, prosecutor or court;
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5)pathoanatomical post-mortem examination.
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5.According to the nomenclature of free services indicated in parts 1, 2, 3, and 4 of this Article, free services shall be rendered to all permanent residents.
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6.The Ministry of Health must deliberate and approve during the final quarter of each calendar year, lists established for the coming calendar year of requisite diagnostic measures of diseases, standard treatment methodologies and a requisite assortment of medicines and other preparations for medical use, necessary for rendering free services at LNHS institutions.
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7.Lists of diseases, whereby free services are rendered, shall be approved during the final quarter for the coming year and openly published in accordance with the procedure established by these institutions.
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Article 86The Range of Free Services
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1.The range of free services shall include:
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1)the nomenclature of free services rendered to individuals in the categories established in Articles 84 and 85 of this Law;
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2)the assortment of free services according to the nomenclature of the services listed in Article 84 and 85 of this Law;
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3)the number of free services of the established assortment.
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2.The assortment of free services shall include the requisite diagnostic measures of diseases and treatment measures thereof, in accordance with the treatment methodologies approved by the Minister of Health.
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Article 87The Procedure of Establishment of Ranges of Free Services
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and Sources of the Funding Thereof 1. The Ministry of Health shall approve the methodology of establishment of the range of free services.
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2.During the last quarter of the current year, the Government and municipal authorities shall establish and approve the range of free services for the coming calendar year (according to the level of organising of LNHS activity). The approved ranges of free services shall be openly published by all public media.
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3.The state and municipal budgets shall be the funding sources for free services rendered to the population at LNHS institutions .
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Chapter II
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THE PROCEDURE OF RENDERING FREE SERVICES
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Article 88The Basic Conditions for the Rendering of Free Services at LNHS
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Institutions 1. The basic conditions for rendering free services at the LNHS institutions are:
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1)a patient requesting free services of physicians, employed at institutions of primary organisation level of LNHS activity, in the residential area of the patient (further - primary health care physician). The Ministry of Health shall approve the list of specialities of these physicians;
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2)a patient requesting free services at the institutions of secondary and tertiary level of organising of LNHS activity. In this instance, the patient must furnish a referral from the primary care physician, concerning the rendering of free services, with the exception of instances, whereby the patient has approached them concerning AIDS, and contagious skin diseases transmitted through sexual contact;
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3)a justification of the need for further free services at another institution and a characterisation of the free services rendered, submitted by the LNHS institution, which is sending a patient to another LNHS institution, in accordance with the requirements approved by the Ministry of Health.
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2.The requirements presented in part one of this Article shall not be applied to patients who contact LNHS institutions concerning the rendering of requisite medical aid.
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3.The Government shall stipulate the basic conditions for rendering free services by the closed budgetary institutions of the Ministry of National Defence and the Ministry of Internal Affairs.
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Article 89The Procedure of Rendering Free Services at LNHS Institutions
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1.Free services at institutions of the primary level of organising of LNHS activities, located within a corresponding municipality, shall be rendered only for the population of that municipality only.
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2.Free services at institutions of the secondary level of organising of LNHS activities shall be rendered to permanent residents of a corresponding county only.
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3.Only institutions of the secondary level of organising of LNHS activities, that are included on the list, approved by the Ministry of Health, may render free services to permanent residents of several counties or of all of Lithuania.
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4.Free services shall be rendered to permanent residents at institutions of the tertiary level of organising of LNHS activity, regardless of their place of residence.
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5.The hospitals of Vilnius University and the Kaunas Medical Academy shall render free services in primary and secondary health care in accordance with the procedure and range established by the Ministry of Health, for the purposes of science and instruction.
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6.Requisite medical aid shall be provided free at LNHS institutions, regardless of the number of visits to the institution by the patient during the calendar year and his place of residence.
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Article 90The Planning of Allocations for Free Services from the State
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and Municipal Budgets 1. State and municipal budgetary funds for the financing of free services are allotted and approved in the state and municipal budgets.
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2.The Ministry of Health, having co-ordinated with the Ministry of Finance, shall approve the methodology of calculation of the funds allocated for the funding of free services.
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3.The minimal allocations from the state and municipal budgets, slated for the funding of free services during the calendar year, may not amount to less than the budgetary allocations slated for this purpose during the past calendar year.
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4.The institutions of the higher level of organising of LNHS activities, which render free services, shall not have the right to receive higher allocations for rendering these services, than those established for institutions of a lower level of organising of LNHS activities.
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Article 91The Compensation of the Differences between the Basic and Actual
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Costs of the Free Services Received by the Patients Who Choose the Services not Included within the Range of Free Services 1. If the persons who, according to the procedure established by laws have a right to all of the free services, shall in using free sanatorium resort treatment and also out-patient treatment services choose of their own initiative, services that are not included within the range of free services, the differences between the actual costs of the services selected by them and the basic costs of the free services, shall be compensated from the state and municipal budgets, according to the procedure established by the Government.
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2.If the persons, insured by compulsory health insurance, who however, have not paid all of the compulsory insurance payments, are making use of free sanatorium resort treatment and also out-patient treatment, and upon their own initiative opt for the services not included within the range of free services, they shall pay the difference between the actual costs of the services they select and the basic costs of free services themselves, according to the procedure established by the Government.
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3.If the persons, insured by the compulsory health insurance, are making use of free sanatorium resort treatment and also, out-patient treatment services and of their own initiative, select services that are not included within the range of free services, the differences between the actual costs of the services selected by them and the basic costs of free services, shall be compensated from the budget of the compulsory Health Insurance Fund, according to the same procedure, which has been established by the Law on the Health Insurance, for compensation of the costs of analogous services.
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4.If the persons, who according to the procedure established by laws, have the right to all free services should while using free in-patient services, choose of their own initiative, services that are not included within the range of free services, they shall pay the difference between the actual costs of the services they select and the basic costs of the free services, according to the procedure established by the Government.
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5.The Government and the executive institutions of local municipalities shall have the right to transfer funds slated for financing free services, to the compulsory health insurance fund and grant it the right to dispose of these funds.
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Article 92Information of Population Members Concerning Free Services
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and the Liability of Institution Heads and Health Care Specialists Institutions must furnish information for the population concerning the types of free services available and the range of rendering thereof. The Ministry of Health shall establish the procedure of providing this information.
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Chapter III
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THE PROCEDURE OF RENDERING SERVICES GUARANTEED BY HEALTH INSURANCE at INSTITUTIONS
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Article 93The Procedure of Rendering the Services Guaranteed by Compulsory
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Health Insurance at Individual Health Care Institutions 1.The procedure of rendering services guaranteed by the compulsory health insurance shall be established in every contract of a LNHS health care institution with the area patients’ fund.
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2.The services guaranteed by the compulsory health insurance and the costs thereof shall be openly published at every institution.
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3.Every person shall be entitled to information on the range and costs of services guaranteed by compulsory health insurance.
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4.Patients within the LNHS system, desirous of obtaining services not included within the range of those guaranteed by the compulsory health insurance, shall cover the difference between the actual and guaranteed costs.
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5.In order to obtain these services, persons entitled to services guaranteed by the compulsory health insurance, must submit to these institutions the documents designated by the laws.
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6.Treatment boards of the institutions shall delegate 3 representatives per institution for negotiations with the area patients’ funds concerning organisation of compulsory health insurance services.
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Article 94Procedure of Rendering the Services Guaranteed by Supplemental
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Health Insurance by Individual Health Care Institutions 1. The procedure of rendering individual health care services guaranteed by supplemental health insurance shall be established in the contract of the LNHS health care institution with a health insurance organisation.
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2.Each person shall be entitled to information concerning the range and costs of the services guaranteed by supplemental health insurance.
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Chapter IV
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THE PRINCIPLES OF PROVIDING SERVICES ACCORDING TO HEALTH PROMOTION ACTIVITY CONTRACTS AND PAID SERVICES
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Article 95Services According to Health Promotion Activity Contracts
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and the Principles for the Provision Thereof The services according to health promotion contract include:
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1)supplemental individual health care services which are not included in the range of free services according to the procedure established in Articles 85, 86, and 87 of this Law;
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2)individual health care services, which are not included among the services guaranteed by compulsory insurance;
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3)all of the public health care services, which are not included in the nomenclature of requisite public health care measures, approved by the Government.
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Article 96The Principles of Providing Paid Services
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1.The nomenclature of paid services, their provision and procedure for the payment thereof shall be established by the Law on the Health System.
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2.The Government shall establish the principles for formation of paid services and the principles for the expansion of their assortment.
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3.The information regarding paid services shall be openly published.
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PART V
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CONCLUDING PROVISIONS
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Article 97Liability for Violations of this Law
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The legal and natural persons, in violation of the requirements of this Law, shall be held liable in accordance with the Laws of the Republic of Lithuania.
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Article 98Procedure for the Coming into Effect of the Law on Health Care
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Institutions 1. Articles 1, 2, 4, 5, 11 and 12, part 1 of Article 14, part 1 of Article 15, part 1 of Article 17, Article 19, parts 1, 2 and 3 of Article 21, Articles 23, 24, 25, 26 and 27, parts 1, 2 and 3 of Article 28, Article 57, part 1 and 2 of Article 58, with the exception of paragraph 2 of part 2, parts 1 and 3 of Article 59, Articles 61, 65, 66 and 67, parts 1 and 2 of Article 68, Articles 70, 71, and 72 , Article 73, Article 74 (taking into consideration the procedure for coming into effect of part I, Chapter II, second and third sections), Articles 75, 76, 77, 78 and 79, Article 80, with the exception of its paragraph 3, Article 82, parts 1 and 2 of Article 83, parts 1 and 4 of Article 84, Article 85 with the exception of paragraphs 2 and 3 of its part 1, and paragraphs 1,2 and 4 of part 2, paragraph 2 of part 3, and part 6, part 1 of Article 86, parts 2 and 3 of Article 87, parts 1, 2, 4 and 6 of Article 89, parts 1, 3 and 4 of Article 90, Article 95, parts 1 and 3 of Article 96 of this Law shall come into force from publication of the Law in the “Official Gazette.”
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2.The requirements of the second and third sections of Part I, Chapter II of this Law, for institutions that are being newly established, shall come into effect from publication of the Law in the “Official Gazette.” The institutions already in existence must be accredited for health care activity and registered in the Institution Register by January 1, 1998.
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3.Parts 2, 3 and 5 of Article 91, Chapter III of Part IV of this Law, shall come into effect according to the procedure established by the Law on Implementation of the Law on Health Insurance.
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4.The other parts, chapters, sections, articles of this Law, or their parts, shall come into effect in accordance with the procedure and terms of the Law on Implementation of the Republic of Lithuania Law on Health Care Institutions.
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I promulgate this Law passed by the Seimas of the Republic of Lithuania.
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Algirdas Brazauskas President of the Republic